系统性红斑狼疮患者合并假性肠梗阻  

Intestinal pseudo-obstruction in patients with systemic lupus erythematosus

作　　者：王霞[1] 许书添[1] 胡伟新[1] 刘正钊[1] 李世军[1] 刘志红[1] 章海涛[1] 

机构地区：[1]南京军区南京总医院肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2015年第4期313-318,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金："十二五"国家科技支撑计划课题(2013BAI09B04;2015BAI12B05);江苏省临床医学科技专项(BL2012007)

摘　　要：目的：观察分析系统性红斑狼疮（SLE）患者合并假性肠梗阻（IPO）的临床特点及预后。方法：2004年1月至2014年4月南京军区南京总医院肾脏科住院确诊为SLE合并IPO患者30例,回顾性分析其临床表现、实验室检查结果、影像学特点、治疗及预后。结果：30例SLE合并IPO患者中,女性26例,男性4例,发生IPO时平均年龄（26.1±11.2）岁,SLE中位病程为27.5月,狼疮活动性指数（SLE-DAI）评分（11.2±7.4）分。6例有明确诱因（5例不洁饮食、1例上呼吸道感染）。IPO临床症状依次为恶心呕吐（76.6%）、腹痛（66.7%）、腹泻（56.7%）和腹胀（30%）。腹部平片及腹部CT可辅助诊断肠梗阻,阳性率〉75%,7例患者同时合并肾盂、输尿管积水。96.7%患者存在贫血,9例患者血小板减少,8例患者白细胞减少,4例直接Coombs试验阳性。96.7%的患者补体C3降低,ANA阳性率89.7%,抗ds-NDA抗体阳性率51.7%,抗心磷脂抗体阳性率30.4%,狼疮抗凝物阳性率43.8%,抗C1q抗体阳性率47.4%。29例患者接受激素为主[泼尼松0.6～1 mg/（kg·d）]的免疫抑制剂治疗（其中10例甲泼尼龙冲击治疗,11例丙种免疫球蛋白治疗）,病情均好转出院,IPO好转中位数时间12d。24例患者长期随访（1～60月）,2例死亡,4例行腹膜透析,5例反复发生IPO,至随访终点,肾脏完全缓解率25%,部分缓解率41.7%。结论：SLE累及消化道导致IPO临床相对罕见,但症状较重,容易误诊,早期识别,并及时给予免疫抑制剂治疗。Objective： To observe and analyze the clinical manifestations and prognosis of systemic lupus erythematosus（ SLE） patients complicated with intestinal pseudo-obstruction（ IPO）. Methodology： From January 2004 to April 2014,thirty SLE patients complicated with IPO were enrolled into this retrospective study. Their clinical manifestations,laboratory tests,imaging characteristics,treatment and prognosis were investigated. Results： They were26 females and 4 males,with mean age 26. 1 ± 11. 2 years old. The median history of SLE was 27. 5 months. The SLE-DAI score was 11. 2 ± 7. 4 when IPO occurred. 6 patients had identified the precipitating factor（ 5 cases had unclean food,one case had respiratory tract infection）. The most common manifestions of IPO were nausea and vomiting（ 76. 6%）,abdominal pain（ 66. 7%）,diarrhea（ 56. 7%）,and bloating（ 30%）. More than 75% patients showed intestinal obstruction in KUB and abdominal CT. 7 patients with hydronephrosis and hydroureters concomitantly. Most cases had anemia（ 96. 7%）. 6 patients had thrombocytopenia and 8 patients had leukopenia. The direct coomb＇s tests were positive in 4 cases. All patients had hypocomplementemia,with positive autoantidodies of ds_ NDA（ 51. 7%）,anticardiolipin antibody（ 30. 4%）,lupus anticoagulant（ 43. 8%） and anti-C1 q antibody（ 47. 4%）. 29 patients were treated with intensive immunosuppressive therapy,10 patients received methylprednisolone plus（ 0. 75 ～ 3 g）,11 patients received gamma immunoglobulin therapy（ 15 ～ 100 g）. All of them were improved after therapy. The median remission time of IPO was 12d（ 8 ～ 19 d）. There was 24 patients follow-up one to 60 months,2 died of complications,5 patients had relapse of IPO,4 cases entered ESRD. Patients had stable condition of lupus. Conclusion： SLE complicated with IPO is relatively rare in clinical. The manifestation is diversity and easily missed diagnose or misdiagnosis. Eearly diagnosis and timely immunosuppressive therapy coul

关 键 词：系统性红斑狼疮 假性肠梗阻 治疗 预后 

分 类 号：R593.241[医药卫生—内科学]